Overuse of potentially harmful clinical preventive services is a dangerous and costly problem. The US Preventive Services Task Force (USPSTF) makes C and D recommendations and I statements to help identify services whose appropriate use requires considerations of patient harm. Unfortunately, efforts of researchers, clinicians, and policy-makers to increase the use of clearly beneficial services have overshadowed the important problem of overuse. We propose to establish a Research Center for Excellence in Clinical Preventive Services (UNC-ReCPS) to focus on patient safety, reducing potential harms by improving the appropriate use of clinical preventive services in primary care practice. The Specific Aims of UNC-ReCPS will be to: (1) Generate new knowledge by fostering high quality, innovative, multidisciplinary research to promote appropriate use of potentially harmful clinical preventive services;(2) Lead the development of novel research ideas and methods and train future researchers in these methods;and (3) Disseminate key concepts from systematic reviews and new research findings into the medical literature, into policy, and into the everyday work of primary care practice. We propose to establish a ReCPS Core Office and an integrated research plan. The Core Office will focus on Aims 2 and 3, first identifying what is known about potential harms and then leading collaborations with other groups and individuals to improve research methods, policy-making, and clinical decision-making about C, D, and 1 - rated services. The research plan (Aim 1) consists of 3 interrelated projects on 4 exemplar clinical preventive services. The projects wil furnish important information about the context in which overuse occurs, and test approaches to increasing the attention paid to potential harms. As a whole, they provide pieces to a puzzle of how to build a foundation on which to design, test, and disseminate new strategies to improve the appropriate use of potentially harmful clinical preventive services. PUBLIC HEALTH RELEVANCE: Sometimes clinical preventive services such as screening for cancers or heart disease are used in situations that could harm rather than help the patient. This project establishes a center to help physicians and researchers better understand this fact, and to lead a research program that would help us learn more how we might improve decision-making about the use of these potentially harmful services.